In Madagascar, community care is essential in humanitarian crisis situations

In a situation of humanitarian crisis and faced with the inability of households to meet health care costs, the community care provided by mobile clinics saves the lives of thousands of children.

Angelin Rabezandriny
Angele pendant la consultation externe à Imanombo, commune d'Ankarana, district de Farafangana
UNICEF Madagascar/2022/Rabezandriny
02 August 2022

“It is a relief that health workers come to our community to treat us, and with free medicines, especially following the passage of cyclones Batsirai and Emnati,” says the mother of a family, Tsofiazy, who came for an outpatient consultation for her daughter Angèle, 12 months, at the mobile clinic at the Imanombo site, in the South- East of Madagascar.

The small town is more than 20 km from the nearest health centre, thus requiring payment of Ar 8,000 Ar or 2 dollars to get there by car.

We only go there when the illness is serious because it is beyond our means. This explains why my daughter has not yet been treated: she has had a cough and a fever for almost a week. In addition to the costs, one must have money to buy medicines; this is not possible for me,” she continues.

The Imanombo area is among the most affected by cyclones Batsirai and Emnati, which hit the island last February. The population and social services suffered significant damage. Although health care at the centre has resumed, the affected community is struggling to properly benefit from it. The loss of housing, arable land or subsistence activities has forced them to prioritize vital needs such as food and housing to the detriment of health monitoring.

If Angèle gets worse, we should get prepared to be referred to the Health Centre with all the related costs. For the moment, we are still cautiously observing the evolution of her state of health. We have a community health worker here, but he lives about six kilometres away and only deals with malaria cases. He is not trained to diagnose and treat other illnesses. He has no inputs either and logically redirects us to the health centre,” she explains.

The mobile clinic is a great help and offers her every hope of benefiting from a quality medical follow-up. “Here, my daughter is accessing treatment as well as nutritional monitoring. The clinic also offers us the possibility of getting vaccinated. My daughter in particular should receive her booster dose of measles vaccine within three months,” Tsofiazy says proudly. This type of mobile service is requested by the communities at least once a month, particularly in this region where the malnutrition situation is deteriorating after these natural disasters. In support, the mothers call for better training of community agents to diagnose childhood illnesses in order to facilitate the approach and the treatments.

For the time being, UNICEF is intervening to mitigate the crisis by providing technical, logistical and financial support in the deployment of mobile clinics to provide community care in the most vulnerable areas of the region. A total of 18 mobile clinics, like the one in Imanombo, are currently covering the five districts of the region for a period of one month.

These mobile clinics are also an opportunity to deliver drugs and therapeutic food to some health centres, given the increased logistical needs after these disasters. The provision of health care to populations isolated or far from health centres is strengthened, and health centres can offer quality services to the populations, in particular women and children who accompany them. Mobile clinics are also used to stimulate demand for services and are an effective means of promoting them.

Rasoarimalala Angele Gabriella, une petite de fille de 12 mois et sa mère Tsofiazy
UNICEF Madagascar/2022/Rabezandriny
Rasoarimalala Angele Gabriella, une petite de fille de 12 mois et sa mère Tsofiazy après une consultation externe à la clinique mobile de Farafangana dans le site d'Imanombo.